How to manage inflammatory bowel disease during the COVID-19 pandemic: A guide for the practicing clinician

Table 3 Management of patients attending outpatient clinic with moderately to severely active inflammatory bowel disease in the scenario of asymptomatic severe acute respiratory syndrome coronavirus 2 infection or confirmed or suspected coronavirus disease 2019[12,20,26,27]

	Management
Asymptomatic infection with SARS-CoV-2	(1) Restrict the use of prednisone ≤ 40 mg/d if necessary; (2) Avoid immunomodulators and tofacitinib; (3) Escalate to biologics as necessary (preferably in monotherapy); and (4) Thromboprophylaxis
Mild COVID-19	(1) Restrict the use of prednisone ≤ 40 mg/d if necessary; (2) Avoid starting or stopping, if in use, immunomodulators, and tofacitinib; (3) Escalate to biologics and dose optimization as necessary (preferably in monotherapy); and (4) Thromboprophylaxis
COVID-19 with pulmonary involvement without SHS	(1) Restrict the use of prednisone ≤ 40 mg/d if necessary; (2) Avoid starting or stopping immunomodulators, and tofacitinib; (3) Escalate to biologics and dose optimization as necessary (preferably) in monotherapy based on balance of benefits and risks; consultation with infectious diseases expert for possible COVID-19 treatment with antiviral or experimental anticitokine therapy; and (4) Thromboprophylaxis

Immunomodulators refer to thiopurines and methotrexate. SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; COVID-19: Coronavirus disease 2019; SHS: Systemic hyperinflammation syndrome.